Persistent hyperhomocysteinemia as an additional prognostic marker beyond the BODE index in COPD

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition. Although multidimensional indices such as the BODE score are widely used for risk assessment, additional biomarkers may improve prognostic stratification. Methods: In this prospective study, 120 patients with stable COPD were evaluated. After standard treatment, plasma homocysteine levels were measured and patients were classified into low (<20 µmol/L, 63.3%) and high (≥20 µmol/L, 36.7%) homocysteine groups. Clinical assessment included lung function, dyspnea severity, and calculation of the BODE index. Healthcare utilization, including hospitalizations, emergency visits, and outpatient visits, was recorded and expressed per patient. Results: Patients with elevated homocysteine levels demonstrated significantly worse clinical outcomes. The mean BODE index was higher in the high homocysteine group compared with the low group (6.3 vs 4.1 points). Mean FEV₁ was significantly lower in patients with elevated homocysteine (34.6% predicted vs 45.5%). Higher homocysteine levels were associated with increased healthcare utilization, including more frequent hospitalizations (0.64 vs 0.34 per patient), emergency visits (2.64 vs 1.22 per patient), and outpatient visits (1.55 vs 1.16 per patient). Notably, increased healthcare use persisted even among patients with comparable BODE scores. Conclusion: Persistent hyperhomocysteinemia identifies a high-risk COPD phenotype characterized by worse lung function, higher BODE scores, and increased hospitalization burden, providing additional prognostic value beyond established indices.

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